Hypnotherapy is being used more and more for losing weight, quitting smoking, and clearing up skin. Is it a simple cure or a dubious stunt?
Catherine was frustrated that, despite training for her first marathon, the 25 pounds she'd gained in the past few years weren't budging. "I was running constantly, but my weight only dropped about five pounds," she recalls. With more skepticism than hope, she met with Jana Klauer, a research fellow at the Obesity Research Center at St. Luke' Roosevelt Hospital in New York City, who treats some weight-loss clients with hypnosis. "At my first appointment, she told me I had to stop eating like a teenager, which essentially meant to stop eating anything sweet and to start eating foods I hated, like seafood," she says. "I walked out of her office thinking that it was impossible and I'd never go back. But I decided to give the relaxation techniques and mantras she used with me in the session a chance." Every night, Catherine, 30, did the homework that supplemented the session: She visualized her goals - being thin and happy, working out in shorts and a sports bra instead of her usual yoga pants and baggy T-shirt. She also mentally repeated statements such as, "I am confident and happy," "Starches and sweets make me feel and look bad," and "I love seafood." Within the first week, she says, she began to crave shrimp (a food she'd previously despised) and lost all her desire for desserts and the office candy jar. There appointments and a month later, she'd lost 15 pounds by sticking to the diet Klauer had suggested for her, and shed an additional five in the next few weeks. "I have to say, I'm now a believer," she says.
Evangelical as she sounds, Catherine isn't the only skeptic to be converted - hypnotherapy is in the midst of a gradual credibility overhaul. Growing support from doctors and psychologists makes it easier to swallow the notion of hypnosis as a behavioral-therapy technique instead of a sideshow stunt. And although the lore of a swinging pocket watch lingers, it's counteracted by hardnosed scientific studies suggesting hypnotherapy's effectiveness at treating problems as complex as anxiety and as blockbuster as weight loss, smoking, and skin disorders. The most staid of medical schools (Harvard, Yale, Duke) teach the technique, and the most recent report by The Journal of the American Medical Association found that among more than 1,000 randomly selected study participants, the number of visits for hypnotherapy increased by 75 percent between 1990 and 1997.
Still, fallacies abound. The classic hokey association - of the subject losing control to a wild-eyed guru - is strictly myth. Instead, hypnotherapists aim to teach patients to focus their minds so keenly that they learn to alter their bodies. The process, according to those who've tried it, creates a heightened state of concentration. "It's not a trance that you can't come out of," says Steven Jay Lynn, a psychology professor at the State University of New York at Binghamton. "You're simply thinking in a deeply involved way. If you want to stop and resist suggestions, you can." And seductive as the hypnotists' lairs in Ambrose Bierce stories are, they bear little resemblance to modern sessions. Patients need not lie down unless they choose to, and while many people prefer to keep their eyes closed, some doctors ask patients to stare at an object during a session, often simply a red tack stuck to a wall.
Hypnotherapy does live up to a few clichés. It often uses exercises such as deep breathing, meditation, of suggestions, the cornerstone of hypnotherapy - statements like "You're getting very sleepy" or "Your eyelids are getting heavy." And hypnotherapists are indeed trained to speak in soothing tones and slow the pace of their voices to coax their subject into a calm state.
Patients report feeling peaceful and relaxed yet self-aware during sessions, much like the enlightened feeling that meditators describe. Indeed, there is "some overlap with meditation," explains David Spiegel, director of the psychosocial treatment laboratory at Stanford University School of Medicine and coauthor of Trance &Treatment: Clinical Uses of Hypnosis (American Psychiatric Publishing). "But hypnosis focuses on the ability to do something for a specific purpose." Hypnotherapists say that statements like "Your body is precious" put the client in a fully relaxed state in which she can focus so intently on the meaning that her behavior should change as a result.
This Pollyanna-ish attitude may be partly responsible for hypnotherapy's success. Particularly for patients who want to lose weight, one of the therapy's basic guiding principles is to focus on a bright future. A University of Connecticut review of six weigh-loss studies found that 70 percent of study participants rated hypnosis better than cognitive therapy alone. Many practitioners find that therapy is most effective when it zeros in on changing upcoming behavior, not belaboring the sins of the past. Klauer's spin on this approach is situation-specific. She asks a client to sit quietly at home before a dinner party an imagine everything she can about the occasion - the dress she will be wearing, the people who will be there, the food that will be served. For instance, she'll say, "you're walking toward the buffet table. You see a cheese plate and shrimp cocktail. You pick up a piece of shrimp and taste how fresh it is." This dry run is meant to enable the patient to short-circuit potential temptations: "She imagines herself choosing something healthy to eat and feeling triumphant in the situation," Klauer explains. "It boosts her confidence, which prevents that first slip that is often all it takes for people to go off their diets." Hypnotherapists also target the patient's main food problem, such as portion control or bingeing.
Girding willpower with positive thinking is also the treatment for smokers looking to quit. "If you tell patients, "Don't smoke," it's like telling her, "Don't think about a pink elephant," says Arreed Barabasz, director of the laboratory of hypnosis research at Washington State University in Pullman and coauthor of Hypnotherapeutic Techniques (Brunner-Routledge). "All she'll think about is pink elephant. The suggestions must emphasize what you're against." Anti-smoking sessions are rife with statements like, "You are respecting the health of your body" and "Imagine your lungs becoming cleaner every day that you don't smoke." When Barabasz tested that approach with 300 heavy smokers who had quit and relapsed, almost half stayed smoke-free 18 months after hypnotherapy - compared with a 10 percent success rate for nicotine-replacement therapy alone.
If hypnotherapy sounds like a genial, soothing kind of treatment, it is. Its other key underlying principle is relaxation - which is particularly crucial when treating skin problems. "The skin is the most expressive organ in terms of emotional stimuli," Barabasz says. The classic evidence, often cited in hypnotherapy literature, is a 1962 Japanese study in which subjects were falsely told that y they were being rubbed with poison ivy, yet they still developed a rash. When researchers reversed the test - they rubbed subjects with poison ivy but told them it was a harmless leaf - they had no skin reactions. Although few studies on its effectiveness in this realm exist, hypnotherapists believe, based on anecdotal evidence, that the conditions best helped by hypnosis are tension related, such as eczema, psoriasis, acne, and habits such as picking at the skin and obsessive hair pulling (trichotillomania). "I'll tell a patient to imagine that she's swimming in warm water on a tropical island or feeling the warmth of the sun on her skin while she lies on a rock by the water," Barabasz says. "It relieves the motional tension that's behind the problem." And since pimples, eczema rashes, and dryness get worse when scratched, suggestions also focus on resisting those urges. The patient might be told to scratch another area of the body or even another object. For instance, in one 1976 case study, patients were taught to scratch dolls whenever they had the urge to touch their skin. This breaks the psychological connection between the compulsion and the behavior while also allowing the affected area to heal.
Solid answers as to whether hypnotherapy is the panacea extolled by some or the mild placebo described by some traditional doctors may not exist, but the truth likely lies somewhere in between. For the practitioners and patients, that may be enough. As Catherine puts it: "I don't care why it worked. What's important to me is that it did."
A patient's motivation determines whether or not she can become hypnotized. While it's a misconception that certain personality traits (such as gullibility) make people easy prey for hypnotists, it is true that some people are more receptive than others. Although studies have found that 60 to 80 percent of people who are hypnotized respond, there are no surefire ways to predict who will and who won't. One indication, however, is simply whether the patient believes the therapy can work 'Studies show that being able to imagine getting positive results form the treatment is enough to rid the patient of the skepticism that would prevent her from being hypnotized," Steven Jay Lynn says. Essentially, hypnosis makes use of a placebo effect, "but the difference is that it's not tricking the patient," Lynn says. 'You're not asking patients to believe in something that doesn't exist - you're asking them to expect positive outcomes based on their own behavior, and that alone can cause the positive outcome."